Administration of Olanzapine to Prevent Postoperative Delirium in Elderly Joint-Replacement Patients: A Randomized, Controlled Trial

Larsen, K. A.; Kelly, S. E.; Stern, T. A.; Bode, R. H.; Price, L. L.; Hunter, David J.; Gulczynski, D.; Bierbaum, B. E.; Sweeney, G. A.; Hoikala, K. A.; Cotter, J. J.; Potter, Adam W.

doi:10.1176/appi.psy.51.5.409

Cited by 96 publications

(105 citation statements)

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“…Of these 10 studies, two focused on the treatment of post-operative delirium with the use of haloperidol, [17] morphine, [17] or ondansetron. [19] Six studies evaluated the role of haloperidol, [18•] dexmedetomidine, [21] ketamine, [23], risperidone, [24] rivastigmine, [25] and olanzapine [22] to prevent delirium. Two additional studies evaluated the depth of sedation versus normal anesthesia care, using bi-spectral index monitoring (BIS) monitoring, in the prevention of post-operative delirium [20, 26•].…”

Section: Resultsmentioning

confidence: 99%

“…Studies primarily focused on older adults. Study populations included cardiac surgery in four [21, 23–25], orthopedic surgery in two, [20, 22] and non-cardiac surgeries in two trials [18•, 26•]. The interventions were predominantly pharmacologic treatment to attenuate risk of delirium, but two of the studies looked specifically at the depth of anesthesia as a risk factor for developing postoperative delirium.…”

Section: Prevention Of Post-operative Deliriummentioning

confidence: 99%

“…The randomized, double-blind placebo-controlled trial by Larsen et al [22] evaluated the efficacy of olanzapine 5 mg orally just before and after elective knee or hip replacement surgery in preventing delirium among 495 elderly (≥65 years) patients. Comprehensive evaluation tools for delirium including DSM-III-R, MMSE, [27], CAM [32], and Delirium Rating Scale-Revised (DRS-R-98) [33] were utilized.…”

Section: Prevention Of Post-operative Deliriummentioning

confidence: 99%

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Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Khan

Gutteridge

Campbell

2015

Curr Anesthesiol Rep

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Delirium is highly prevalent among elderly post-operative patients with no pharmacological intervention approved by the Food and Drug Administration for prevention or treatment. We conducted a systematic evidence review to critically appraise literature related to the pharmacotherapy of post-operative delirium. Ten studies fulfilled our inclusion criteria with two interventions for delirium treatment and eight interventions for delirium prevention in post-operative patients. The quality of evidence of delirium treatment studies was poor, whereas the quality of evidence in delirium prevention studies ranges from moderate to high. Delirium treatment studies find similar delirium duration and length-of-stay outcomes between haloperidol and either morphine or ondansetron. Risperidone was found to reduce the conversion of sub-syndromal delirium to delirium in one study compared to placebo. Haloperidol, olanzapine, and ketamine were each found to reduce delirium incidence, whereas rivastigmine had no impact on delirium incidence or duration. Lighter anesthesia as monitored by bi-spectral index led to a decreased delirium incidence. Considering results from studies conducted prior to the dates of this review, the current evidence suggests that certain pharmacologic classes and lighter sedation using BIS monitoring may prevent post-operative delirium, although a conclusive recommendation for clinical practice must await further research.

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Section: Resultsmentioning

confidence: 99%

Section: Prevention Of Post-operative Deliriummentioning

confidence: 99%

Section: Prevention Of Post-operative Deliriummentioning

confidence: 99%

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Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Khan

Gutteridge

Campbell

2015

Curr Anesthesiol Rep

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“…[12, 49–53] Currently there is an ongoing Dutch multicenter trial (Haloperidol Prophylaxis in Older Emergency Department Patients, HARPOON study) to determine efficacy and safety of haloperidol prophylaxis in at-risk patients. [54] Medical and surgical patients identified as high risk for delirium in the emergency department will be randomized to 1 mg haloperidol prophylaxis twice daily for seven days with delirium incidence as the primary endpoint, and secondary endpoints including delirium free days, length of stay, and mortality.…”

Section: Current Controversies and Future Considerationsmentioning

confidence: 99%

Postoperative Delirium in the Geriatric Patient

Schenning

Deiner

2015

Anesthesiology Clinics

110

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SYNOPSIS Postoperative delirium, a common complication in older surgical patients, is independently associated with increased morbidity and mortality. Patients over the age of 65 years receive greater than 1/3 of the over 40 million anesthetics delivered yearly in the United States. This number is expected to increase with the aging of the population. Thus, it is increasingly important that perioperative clinicians who care for geriatric patients have an understanding of the complex syndrome of postoperative delirium.

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“…Although haloperidol and various atypical antipsychotics have been used in the management of delirium in the past, there have been no reports to date proving their efficacy as treatments for ICU delirium, including postoperative delirium,223, 224, 225, 226, 227 and there are only a few studies that can assert to the efficacy of quetiapine 228. Currently, while the use of antipsychotics may slightly reduce the frequency of delirium onset, the consensus is that their routine use is not recommended, as it does not ultimately lead to improved patient prognosis while exposing them to various side effects including extrapyramidal symptoms, torsade de pointes, and ventricular arrhythmias 229.…”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Administration of Olanzapine to Prevent Postoperative Delirium in Elderly Joint-Replacement Patients: A Randomized, Controlled Trial

Abstract: Administration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.

Cited by 96 publications

References 0 publications

Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Postoperative Delirium in the Geriatric Patient

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

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